Exploring new treatments for migraine sufferers

When it’s more than just a headache

By Rob Levey

New and non-traditional treatments are giving migraine patients hope that they will experience less pain and fewer headaches from the neurological condition.

Is it a migraine?

Tension headaches are characterized by pain around the top and both sides of the head and neck, but migraines are much more severe and usually accompanied by extreme sensitivity to light, sounds and smells. Additional symptoms include nausea and vomiting, changes in vision, difficulty sleeping, anxiety and depression.

A migraine, however, is not simply a bad headache, according to Ryan Khalsa, DC of Dynamic Chiropractic.

“It is a neurological condition that effects the sensitivity of the part of the nervous system that deals with regulating pain,” he said. “The result is heightened pain perception due to a lack of ability for the brain to ‘dampen’ pain signals.”

He said those that suffer from migraines have brains that are genetically predisposed to become easily excitable. He said they also lack strong inhibitory control over key areas of their brain.

“This tendency for head pain is just one feature of a broader migraine ‘disease,’” said Dr. Khalsa, who treats patients at Whole Life Health Care in Newington.

Noting approximately 30 percent of adults have reported experiencing one, Mary Lynn Fahey MS, ARNP, Nurse Practitioner at Whole Life Health Care, said migraines are often distinguished by pain on one side of the head. She said many describe it as “pulsating.”

“Migraine sufferers often can't engage in usual activities while having headaches,” she said.

Although not experienced by everyone, one classic symptom is an aura. Geoffrey Starr, MD of Core Neurology, located in the Center for Orthopedics & Movement in Exeter, described it as a visual phenomenon that precedes a migraine.

“It comes out of the blue and the person develops flashing lights or zig-zag lines,” he said. “It may come on slowly, too, and gradually worsen.”

Triggers

Before deciding on a treatment for migraines, Fahey said it is important to first understand what may be causing or triggering them.

“The individual is often asked to keep a headache log to track when headaches occur, what their diet and activity were like at the time,” she said. “We also ask them to track any symptoms that happened before or with the headache, how they treated it and how long it lasted.”

According to Dr. Starr, the key for migraine sufferers, though, is to first recognize that what they are experiencing is not a headache.

“A lot of people are walking around and writing them off as headaches, tension headaches,” he said.

In such instances, these individuals often turn to over-the-counter products or use caffeinated products. “When the medicine wears off, it triggers another headache,” said Dr. Starr, who referred to these episodes as analgesic-rebound headaches. “Migraines that were once a month turn into once a week and then daily.”

Treatment

According to the experts, there are many new treatments available for migraines from both a traditional and non-traditional perspective.

In regards to traditional approaches, Matthew Robertson, M.D. with Appledore Medical Group in Portsmouth said regular migraine sufferers have historically taken daily medications that were originally designed for blood pressure management.

“Many of these medications work reasonably well, but often have limiting side effects,” he said. “More recently, Botox injections every three months have been used with good efficacy to reduce migraine frequency and severity.”

He said there has also been renewed success and interest in a simple clinic-based procedure that targets the sphenopalatine ganglion called SphenoCath.

The SphenoCath device delivers anesthetic through the nasal cavity, effectively delivering a sphenopalatine ganglion block for migraine pain, according to the company.

“It has worked quite well for both migraines and other types of head pains, including trigeminal neuralgia,” he said.

According to Dr. Khalsa, one newly discovered, non-invasive, drug free treatment for migraines is Pneumatic Ear Insufflation therapy, which he said can provide immediate relief of pain. It involves using a simple device called an insufflation bulb that attaches to a common instrument used to look inside the ear known as an otoscope.

“The insufflation bulb creates a suction on the ear drum, which moves the ear drum in and out,” he said. “Within minutes, a person in the midst of a migraine can be completely free of pain by creating this movement on the ear drum.”

Noting that the reason as to why this works to decrease pain during a migraine is still being studied, he said it is theorized that moving the ear drum in this manner during a migraine stimulates a specific nerve.

“This nerve is linked to a key area of the brain involved in a migraine called the trigeminal nucleus,” he said. “This stimulation overrides the pain of the migraine. In the cases where it works for people, the effect is immediate and long-lasting.”

From a nontraditional perspective, Dr. Robertson said there are certain herbal supplements that have been reasonably well studied with proven efficacy in migraine prevention. When taken at 75 mg twice daily, Butterbur has been shown to reduce migraine frequency and severity. He said there are issues, however, with relying on herbal supplements.

“The trouble is that there is no guarantee as to the exact amount of active ingredient in any given pill, which can lead to varying results,” he said. Talk to your doctor before starting an herbal supplement regimen.

Other nontraditional treatments include several devices that rely on supraorbital (above the eye) transcutaneous (through the skin) electrical stimulation, which have been shown to help with migraine frequency. “These devices, such as Cefaly, are placed on the forehead once or twice per day and provide pulses of electrical stimulation,” said Robertson.

Fahey cited other alternative methods to treating migraines.

“Acupuncture, biofeedback, and massage therapy have been found effective by many migraine sufferers,” she said.

In looking ahead at the treatment of migraines, Dr. Starr expressed enthusiasm at a new class of drugs that are being tested that he says possess different mechanisms of action.

“They could be more effective than the ones we have now with less risk and side effects,” he said.

Rob Levey is CEO of Exponential Squared, a marketing and organizational development company focused on helping small to medium businesses achieve their business goals and promote wellness in the workplace. Rob never strays too far from his roots – you will find his freelance writing in numerous publications, including Parenting NH.